"WHAT?!?!!!?!", quotes the EMS.....

[ERDoc]

Hey RBE....

I didn't exactly trust her "PA expertise" due to the simple facts that

1. she waived me away like some royal bimbo from her precious throne behind the nursing desk. That kind of professionalism goes ohhhh such a LONG way with me...lol.

2. she didn't have an EKG and/or good reason quite frankly for calling it, other than the fact that the guy died in the geri chair in front of the nurses station with them all sitting there. They never knew he'd passed on till they went to move him!! BTW, no liv or rig set in yet. Like I posted above, he was warm, warmer than me!!! :shock: :?

Something about this post just rubs me the wrong way. You sound like you have something personal (not professional) against this PA. Your description alone lacks in professionalism. She told you that she pronounced the pt and called you off. So she was being unprofessional? I just don't see it. As Richard B. said, check with your local jurisdiction as to who can pronounce. In NYS anyone can pronounce someone, but only a licensed physician can sign the death certificate (yes, there is a difference). It is not uncommon for a PA, or a nurse for that matter to pronounce someone.

You do not need an EKG to declare death. Good clinical skills will suffice. Working in a healthcare facility (be it a hospital or NH), the rules are much different than they are in the field. There are probably plenty of good reasons that this guy was pronounced, you just may not have been aware of them. If you use lividity or rigor mortise as your criteria to pronounce, you will be working many useless codes in your career (but I have to give the benefit of the doubt, this may be what your protocols say). What is the big deal if he died in front of the nursing station? How many times have you walked into a NH to find several residents sleeping in front of the nursing station? Should they be checking pulses on everyone that sleeps? Seems a little overboard and rediculous.

I have seen many NH disasters, but I don't see anything wrong with the case that you bring up (though you have more of the facts than I do). You sound like you have something personal against this particular PA or were offended by the fact that you were asked not to do anything after someone with higher authority pronounced the pt.

[Laura Anne]

Nope, nothing personal against the Pa. In fact, this was my first run-in with her.

You don't see anything wrong with a person who doesn't have the decency to provide me any medical history, events leading up to the incident, or even the decency to make eye contact with myself or my crew? Well, I am sorry....but that right there is why I went and checked up on the patient myself. Plus, she never stated who she was and refused to come to the patients bedside when asked. I didn't know if she was a CNA, RN, Md, Do, etc. until I asked one of the RNs who came in to the room to help us. If I cannot be informed of the proper status of a patient with the courtesy of a fellow provider, then my gut feeling is to double check and thats what I did. No, we don't need to have lividity and rig to pronounce someone, either. I know my job, I know my protocols, and I trust my gut when a critical call like this comes up. I would question the person who would turn and walk out without getting the info needed from the NH.

So once again, a positive, happy thread on this site has turned into a nasty, bitch session. Job well done, Doc!! :roll:

[Asysin2leads]

Laura Anne, I can see it from both sides of the fence.

First, if I was the PA AND I had full rights to declare death (and given that PA's are physician extenders I don't see why they can't with or without an OK from an online/telephone physician), and I called it, declared death, and 911 still showed up demanding access to the patient and their medical history, I might get snippy too, the same way I might get snippy if I had pronounced and the firefighters insisted on checking a pulse. The PA was probably having a bad night. Also, its stressful declaring people dead. Unfortunately, due to some of the less well trained and professional people in our service, many health care professionals have had poor experiences with EMS. It happens.

[ERDoc]

Nope, nothing personal against the Pa. In fact, this was my first run-in with her.

You don't see anything wrong with a person who doesn't have the decency to provide me any medical history, events leading up to the incident, or even the decency to make eye contact with myself or my crew? Well, I am sorry....but that right there is why I went and checked up on the patient myself. Plus, she never stated who she was and refused to come to the patients bedside when asked. I didn't know if she was a CNA, RN, Md, Do, etc. until I asked one of the RNs who came in to the room to help us. If I cannot be informed of the proper status of a patient with the courtesy of a fellow provider, then my gut feeling is to double check and thats what I did. No, we don't need to have lividity and rig to pronounce someone, either. I know my job, I know my protocols, and I trust my gut when a critical call like this comes up. I would question the person who would turn and walk out without getting the info needed from the NH.

So once again, a positive, happy thread on this site has turned into a nasty, bitch session. Job well done, Doc!! :roll:

First of all, the nastiness started with the OP and the subsequent post berating and putting down the PA. Describing someone as a royal bimbo on her throne is not exactly positive is it? If you were here long enough you would know that I do not get involved in most of the little nit picking that goes on. I try to avoid those threads except when facts/knowledge need to be added (which is part of the reason I have not posted in a long time). If you wanted to avoid making this thread your personal bitch session you could have left out the part about the PA and still gotten your point across. It would probably go a little like this:

I got called to a NH and went to check on a guy in cardiac arrest. The staff told me that he was blind, but in a blonde moment I checked the pupils. Silly me.

See, positive and gets the point across while leaving out the negative, irrelevant parts and berating of another healthcare professional. I will agree with you on one point. The PA should have identified who she was. It does not matter if she was having a bad night, she should have identified herself. Saying something as simple as, "Hey guys. Thanks for coming so quick. I'm Mary the PA here tonight. I just pronounced Mr. Jones. Sorry to bother you."

Once she has said that there is no reason for you to need any more info or for you to go to the bedside. Ambulances are not for corpses.

[MSDeltaFlt]

lol@subject! Were you a cop dispatcher in a previous life?

First thing we have to teach cop dispatchers about dispatching EMS: Our patients are not "subjects", our callers are not "complainants", and don't preface every statement with "be advised".

But the most memorable "duh" moment that comes to mind was from back in my EMT days. Went to pick up some school girl at a suburban ER and transfer her to a larger hospital. Her diagnosis was meningitis. Thinking I would impress the ER doc with my vast knowledge of hospital medicine, I asked him if he'd done an LP on the patient. He just shot me an annoyed look and said, "No, I just used my tricorder". :oops:

Back during my respiratory days:

Did you know that a bottle of Tincter of Benzoin does NOT need to shaken well before use? ...especially while the flip top is still open? Boy, those nurses were pissed.

[ERDoc]

Back during my respiratory days:

Did you know that a bottle of Tincter of Benzoin does NOT need to shaken well before use? ...especially while the flip top is still open? Boy, those nurses were pissed.

That must have been hilarious (unless you happen to be one of the nurses).

[MSDeltaFlt]

That must have been hilarious (unless you happen to be one of the nurses).

All over the nurses, patient, code chart... the TV on the far wall. Yeah, it was bad.

[firedoc5]

I think we've all had our moments. But it's easier talking about someone else's. Like one day had a rookie medic say that "the patient has good neuro deficits". Or the veteran medic report that the patient had good pedal pulses bilaterally, when in fact his left leg was a prostetic limb. I myself one day for some reason, I think I was laughing, couldn't pronounce "post-ictal" and just said that "the patient seemed out of it." She was obviously faking it, that's why we were laughing.

[Mateo_1387]

Or how about the medic that said "we are en route to your facility with a patient who has a decapitated hand"

[Laura Anne]

Just had a medic the other day state to the crew coming to back him up on a code, "hey guys, he's got dependent rigormortis and lividity in his fingers." The other crew looked at him and said, "you mean dependent liv. and rig in fingers....?" :roll: